Ultrasound can also be used to identify bony injury – notice the disruption of the cortex of the distal fibula of this teenager who jumped off a wall. Normally bone appears hyperechoic (bright white) with shadowing behind. Remember that growth plates will also appear as a disruption in the cortex, but this tends to be narrow with smooth edges. You can also notice a hematoma just superficial to the cortex (homogenous echotexture as opposed to striated muscle or fat that appears heterogeneous).

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